The number of inmates suffering from mental disorders in correctional institutions has burgeoned considerably in recent years. Consequently it is the single most important issue in corrections today. The task of correctional institutions is twofold,
firstly they serve to reprimand and punish offenders who have run afoul of the law and secondly the focus is on reform and reintegration into respectable society. Daunting and challenging as the task is, it has been complicated immeasurably on account of the number of inmates battling with mental health issues as their special needs must be attended to in addition to the care and management of the other prisoners.
The needs of the said populace tends to throw the smooth functioning of the correctional setting out of joint and gives rise to a host of other problems. In the words of Johnson (2005) , “Unplanned for and unmet needs of mentally disordered offenders can cause significant disruption in the correctional environment and give rise to liability concerns and litigation” (p. 107) . Inmates with mental health issues are very fragile emotionally and they are likely to find confinement threatening. They tend to suffer from depression, low self – esteem, feelings of anxiety, hostility, rage and depression. Therefore these offenders must be dealt with cautiously as they are considered a security risk and are dangerous to themselves as well as others. Furthermore they are a considerable drain on resources. Given the explosive situation, effective treatment of inmates with mental health issues is imperative.
The Prevalence of Mental Disorders among Inmates
In recent times, there is evidence that more and more of the mentally disordered have been shepherded behind bars as opposed to hospitals where they belong. In fact the number of offenders with mental disorders within the correctional setting is disproportionately high. According to Weinstein, Kim, Mack, Malavade, and Saraiya (2005) , “The prevalence of severe mental illness in correctional facilities is significantly higher than the prevalence in the community” (p. 44) .
There are many plausible reasons for the prevalence of mental disorders among inmates. These individuals usually do not manifest overt symptoms of advanced psychosis, fearing stigmatization by the community at large they become rather adept at concealing signs of mental illness. They are not deemed dangerous enough to be institutionalized and are released into the community due to a lack of telltale symptoms. De – institutionalization has also led to increased imprisonment. Often such disturbed members of the populace have trouble functioning in socially acceptable ways and usually get into trouble with the law. They are arrested on charges of violence, homicide, assault, or drug trafficking. Santamour and West have attempted to explain this predilection for breaking the law on the part of the mentally disturbed by suggesting that “… critical cognitive and related personal characteristics of those with mental retardation may contribute under certain circumstances to an unwitting participation in activities that are illegal” (as cited in Gardner, Graeber & Machkovitz, 2000, p. 332) . Public sentiment is largely in favor of incarceration as mentally ill offenders are viewed with prejudice. They are seen as a menace and a threat to the safety of respectable citizens and people feel safer when they are locked away. The courts have also adopted a stricter stand on sentencing law – breakers and therefore all offenses are dealt with severely. All these factors have contributed to increased incarceration and the number of mentally disordered among the incarcerated populace has increased drastically.
Statistical reports bear testament to the increase in the number of mentally disordered offenders. Lamb, Weinberger, Marsh, and Gross (2007) have stated that, The latest methodologically sound estimates of the percentages of persons diagnosed as having severe mental illness range from 10% to 19% of jail populations, 18% to 27% of state prison populations, and 16% to 21% of federal prison populations, as determined by the National Commission on Correctional Health Care (p. 782) .
These findings have been confirmed by a U.S. Department of Justice survey which found that “Psychotic symptoms are reported by 15% and 24% of all prison and jail inmates, respectively” (Lamberti, 2007, p. 773) . In light of these findings, it is apparent that special consideration must be given to this issue before it mushrooms into further trouble. Effective treatment and management of mentally disordered inmates is the best way to curb this situation and curtail its negative ramifications for society. This approach ensures that the mentally disordered offender gets some much needed treatment and hopefully is fully rehabilitated in the long run and successfully makes the transition back into society.
The Need for Treatment Programs
Confinement can be extremely stressful for mentally disordered offenders and it may aggravate existing symptoms or trigger latent ones. Inmates have to adhere to strict rules and are deprived of the freedom and many outside privileges they had hitherto taken for granted. They may have to face harassment from their fellow inmates and correctional officers, struggle with boredom and feelings of resentment, paranoia and anxiety. These conditions are stressful for all inmates but given the precarious states of inmates with mental disorders, the situation can be particularly distressing. If left unchecked or ignored they are likely to become increasingly unstable and unpredictable and are given to bouts of violence, depression and other disruptive activities. In this state there is always the chance that they may harm themselves or others. Treatment programs may well take the edge of the stress, help inmates cope more effectively and make the correctional environment safer. According to Dvoskin and Spiers (2004) , treatment “… serves a proactive protective function by intervening before a situation becomes a crisis, thereby not only alleviating pain in the individual, but also preventing unnecessary disruptive and costly drain on system resources” (p. 46) .
Suicidal tendencies are high among mentally disordered inmates for the reasons outlined above. The American Public Health Association (2003) , has reported that “Suicide is a leading cause of death among persons confined to correctional facilities even though it is largely preventable through a well – functioning mental health program” (p. 60) . Disturbed inmates may be unable to cope with their illness and the attendant stressors of confinement and may choose to take their lives. Treatment programs that focus on detecting suicidal intent, implementing appropriate measures to curb these tendencies and thereby prevent suicide must be devised in order to protect the lives of inmates.
While the practice of incarcerating mentally disordered offenders is debatable, the fact remains that correctional institutions by executing carefully planned treatment policies and procedures are extremely well placed to render invaluable services to these individuals and in the process to society as well. In the words of Kendig (2006) ,
The highly structured, controlled environment of a prison is conducive to managed – care efforts that foster smart medicine, such as clinical practice guideline implementation, formulary adherence, utilization review for elective procedures and diagnostics, monitoring specific outcome measures in disease management, and clinician peer review programs (p.8) .
Structured care can assure the inmate of adequate treatment in the form of medication, counseling, and other forms of supportive therapy. Under the guidance of expert medical health personnel they can fight their affliction and make their way back into society as useful members. Thus effective treatment procedures have implications beyond the correctional setting as these programs uphold the right of mentally disordered inmates to quality health care.
Effective Treatment for Inmates with Mental Health Issues
Providing effective treatment for inmates with mental health disorders is a challenging task for correctional institutions as they have to implement effective treatment policies and procedures besides having to train security as well as health personnel to deal with the problem and establish proper communication channels to ensure cooperation and efficiency among the staff members at all levels. In recent times guidelines for providing adequate treatment have been established by the National Commission on Correctional Health Care (NCCHC), American Public Health Association, and the American Association of Correctional Psychologists. Treatment programs usually incorporate case evaluation, identification, treatment, discharge planning or follow – up procedures.
Norton (2005) recommends that correctional systems “Develop policies that address mentally ill offenders from time of initial intake through their entire sentence” (p. 37) . These policies must be executed carefully and modified regularly as per the needs of the mentally ill inmates in order to derive the maximum benefits. Mentally disordered inmates must be given access to competent care providers like trained physicians, psychiatrists, counselors, psychologists, nurses, correctional staff, and social workers. Training the mental health care team can be costly but it is a necessity as poorly qualified staff may fail to do justice to their charges and are likely to worsen the situation.
The needs of each mentally disordered inmate are unique as they belong to different categories on the diagnostic scale. Categories include disorders like schizophrenia, bipolar, personality and mood disorders, psychoses, substance abuse, mental retardation and sexual offenders. Sometimes inmates may be diagnosed with two or more of the above named disorders. General treatment procedures are likely to include medication, counseling, education, and additional therapy to prevent relapse. Medication can be very effective in managing mentally ill inmates but there may be undesirable side – effects that may cause the patient to opt out from the treatment program. In addition, it must be used judiciously for those with a substance abuse problem. Therefore medication is used sparingly and is usually coupled with other treatment methods. Individual and group counseling have had encouraging results as it can be a cathartic and uplifting experience. Inmates convicted for substance abuse crimes or sexual offences need to be educated to help them develop a healthier attitude towards life. According to Shively (2004) , “Anger management is an essential area for these offenders to gain more control over their rage and their need to get even with others” (p. 85) . Thus a combination of these treatment options needs to woven into the treatment plan on the recommendation of the treatment team. Ideally treatment programs must be carefully tailored to meet the needs of the individual. Therefore despite established guidelines for treatment, there should be room for flexibility.
The available research literature has indicated that the number of offenders with mental disorders is exceedingly high. This has thwarted the aims of the corrections system which is confinement of wrongdoers followed by reintegration into society. By providing treatment for inmates with mental disorders, it is possible to resolve this dangerous situation. Therefore effective treatment is the means to ensure the proper functioning of the corrections system.